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Alpergin BC, Beger O, Özpişkin ÖM, Erdin E, Kılınç MC, Alpergin S, Gündoğan NM, Çalışır ES, Eroglu U. Radiologic evaluation of the Vidian canal in the pediatric population. Surg Radiol Anat 2024:10.1007/s00276-024-03393-y. [PMID: 38780788 DOI: 10.1007/s00276-024-03393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This examination aimed to display the size and topographic position of the Vidian canal (VC) in normal children. METHODS 180 pediatric subjects aged 1-18 years were included this computed tomography examination. The distances of VC to certain landmarks, and VC length were measured. The locations of VC according to the sphenoid sinus, and the medial plate of pterygoid process were classified as three types, separately. RESULTS The distances of VC to the vomerine crest, midsagittal plane, round foramen, and the superior wall of sphenoid sinus were measured as 12.68 ± 3.17 mm, 10.76 ± 2.52 mm, 8.62 ± 2.35 mm, and 14.16 ± 5.00 mm, respectively. The length and angle of VC were measured as 12.00 ± 2.52 mm, and 16.60 ± 9.76°, respectively. According to the sphenoid bone, VC location was identified as Type 1 in 113 sides (47.5%), as Type 2 in 70 sides (29.4%), and as Type 3 in 55 sides (23.1%). According to the medial plate of pterygoid process, VC location was identified as Type A in 274 sides (76.1%), as Type B in 55 sides (15.3%), and as Type C in 31 sides (8.6%). VC location types correlated with pediatric ages, but not sex or side. CONCLUSION With advancing pediatric age, the protrusion of VC into the sphenoid sinus increases, and VC shifts from medial to lateral side of the medial plate of pterygoid process.
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Affiliation(s)
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, 27310, Gaziantep, Turkey.
| | - Ömer Mert Özpişkin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Engin Erdin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mustafa Cemil Kılınç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Selen Alpergin
- Department of Otorhinolaryngology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Ebru Sena Çalışır
- Department of Anatomy, Faculty of Medicine, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Chaudhary N, Jaitly S, Verma RK, Gupta S. The Maxillary Swing: An Efficacious Approach to Surgical Management of Advanced Stage Juvenile Nasopharyngeal Angiofibroma. Indian J Otolaryngol Head Neck Surg 2022; 74:1496-1501. [PMID: 36452751 PMCID: PMC9702283 DOI: 10.1007/s12070-021-02600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibroma. A retrospective case series analysis in a tertiary care centre revealed eighteen cases with extensive nasal angiofibroma operated using the maxillary swing approach between 2011 and 2017. All patients had tumour extension to the lateral most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus. All patients underwent tumour excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumour exposure and vascular control could be achieved in all cases resulting in complete tumour excision. The mean operative time was 3 h 15 min. Post-operative healing was satisfactory with palatal fistula formation in four cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibroma and leads to optimal anatomical exposure with minimal morbidity.
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Affiliation(s)
- Neena Chaudhary
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Shweta Jaitly
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Rajeev Kumar Verma
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
- Srimadhopur, Siker, Rajasthan India
| | - Shashank Gupta
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
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Jadhav S, Khandaitkar S, Mitra K, Chaudhari S, Dhok AP. Juvenile Nasopharyngeal Angiofibroma: An Aberrant Case Report. Cureus 2022; 14:e24350. [PMID: 35607527 PMCID: PMC9124007 DOI: 10.7759/cureus.24350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
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Szyfter W, Balcerowiak A, Gawęcki W, Juszkat R, Wierzbicka M. Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment. Otolaryngol Pol 2021; 75:9-14. [PMID: 33949314 DOI: 10.5604/01.3001.0014.5220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. <br/>Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. <br/>Material and methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach - external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. <br/>Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation.<br/> Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Andrzej Balcerowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Robert Juszkat
- 2 Department of General and Procedural Radiology of the Poznan University of Medical Sciences, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
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5
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Two rare cases of sinonasal vascular malformation in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 138:110192. [PMID: 32705987 DOI: 10.1016/j.ijporl.2020.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/21/2022]
Abstract
Vascular malformations presenting in the nasal cavity and paranasal sinuses are rare. Differentiating benign vascular malformations of the sinonasal cavity from other pathologic entities can be challenging and the role of preoperative angiography and embolization is not well defined. We present two unique cases of large pediatric sinonasal vascular malformations and describe their presentation, diagnosis and subsequent management. Both patients underwent embolization of the ipsilateral arterial supply followed by successful and complete endonasal surgical excision. This report provides description of management of the very rare occurrence of sinonasal vascular malformation in two adolescents.
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Choi JS, Yu J, Lovin BD, Chapel AC, Patel AJ, Gallagher KK. Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database. Skull Base Surg 2020; 83:76-81. [DOI: 10.1055/s-0040-1716676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Abstract
Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.
Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients.
Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.
Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
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Affiliation(s)
- Jonathan S. Choi
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Justin Yu
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Benjamin D. Lovin
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Alyssa C. Chapel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Akash J. Patel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - K. Kelly Gallagher
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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Grachev NS, Vorozhtsov IN, Frolov SV, Polev GA, Gladko VV. [Experience of transnazal endoscopic surgery of juvenile angiofibroma of the skull base and nasopharynx without performing preoperative embolization]. Vestn Otorinolaringol 2020; 85:85-88. [PMID: 32885644 DOI: 10.17116/otorino20208504185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular, blood-supplied, benign tumour affecting the sinuses, nasal cavity, nasopharynx and the base of the skull. For intraoperative hemostasis, pre-operative embolism is a common and recommended procedure, but it has serious disadvantages, such as additional radiation exposure, anesthesia, and the risk of iatrogenic complications associated with the occlusion of the central artery of the retina, orbital and middle cerebral arteries. This article presents a report on successful radical removal of the widespread SAS without resorting to preoperative embolization, but with intraoperative transnazal endoscopic clipping of the internal maxillary artery (IMA).
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Affiliation(s)
- N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.,Medical Institute of Continuing Education, Moscow State University of Food Production, Moscow, Russia
| | - I N Vorozhtsov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - S V Frolov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - G A Polev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - V V Gladko
- Medical Institute of Continuing Education, Moscow State University of Food Production, Moscow, Russia
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Llorente JL, López F. The endoscopic endonasal approach for the treatment of juvenile angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:136-144. [PMID: 29764608 DOI: 10.1016/j.otorri.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Juvenile angiofibroma (JA) is a benign tumour, for which the treatment of choice is surgery. It may be associated with significant morbidity because of its anatomical location and its locally destructive growth pattern. Severe haemorrhage constitutes a high risk in JA and its surgical management can be complex. The management of JA remains a challenge. The objective of this study was to review a series of patients with JA treated via the endonasal/endoscopic approach. MATERIAL AND METHODS Medical records of patients operated for JA were reviewed. MAIN OUTCOME MEASURES tumour stage, intraoperative blood loss, complications and persistence/recurrence rates. RESULTS A total of 30 male patients and one female were included. The mean age was 17 years. Using the Radkowski classification, one JA was classified as stage I, 5 stage IIA, 9 stage IIB, 4 stage IIC, 10 stage IIIA and 2 stage IIIB. Thirty-nine percent of the JA was classified as advanced stage JA (IIIA and IIIB). The mean blood loss was 1.156mL Except in one case, no significant complications were observed. Tumour persistence/recurrence was observed in 2 JA (6%), at the end of the follow-up. Mean postoperative follow-up time was 86 months. CONCLUSIONS This retrospective study supports the notion that endonasal endoscopic approaches for a JA are a feasible option associated with good long-term results.
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Affiliation(s)
- José Luis Llorente
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Fernando López
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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Transoral Finger-Retraction for Endonasal Endoscopic Resection of Masseteric and Buccal Space Lesions. J Craniofac Surg 2019; 30:800-802. [PMID: 30614990 DOI: 10.1097/scs.0000000000004931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lesions involving the masseteric and buccal spaces have traditionally required transoral or transcervical approaches. Herein, the authors describe the successful endonasal endoscopic resection of a juvenile nasopharyngeal angiofibroma (JNA) with significant extension into the masseteric and buccal spaces facilitated by transoral finger retraction. Juvenile nasopharyngeal angiofibromas are hypervascular tumors originating in the pterygopalatine fossa (PPF) with complex relationships to skull base and orbital structures. Endoscopic approaches have allowed for resection of JNAs with excellent visualization and without traditional transfacial approaches, decreasing morbidity and reducing incidence of facial deformity with similar outcomes as open approaches. While the endonasal endoscopic approach to the masseteric and buccal spaces is unconventional, encapsulated tumors in these regions can be delivered into the nasal cavity through the maxilla and PPF with the use of transoral finger-retraction. The authors present a case of a 10-year-old male referred to their tertiary care center with left-sided epistaxis, nasal obstruction, and facial swelling. Imaging demonstrated a vascular lesion in the PPF involving the left nasal cavity and paranasal sinuses, with extension into left middle cranial fossa, infratemporal fossa, orbit, and deep spaces of the neck including the masticator, masseteric, and buccal spaces. The patient underwent preoperative embolization and endoscopic endonasal surgical resection with transoral finger-retraction without complication. Transoral finger-retraction represents a supplemental technique that allows for encapsulated lesions involving the masseteric and buccal spaces to be delivered into the nasal cavity for endoscopic resection in a safe and effective fashion, preventing the need for transfacial incisions.
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Anjum S, Temkar S, Chawla R, Garg G. Occurrence of Hemi-Central Retinal Artery Occlusion Following Embolization in a Case of Recurrent Juvenile Nasopharyngeal Angiofibroma. Ophthalmic Surg Lasers Imaging Retina 2019; 50:385-387. [DOI: 10.3928/23258160-20190605-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
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The Endoscopic Endonasal Approach for the Treatment of Juvenile Angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Abdelwahab M, Overdevest JB, Elmokadem A, El-Sisi H, El-Kholy NA, Zaki H, Kamal E, Khafagy Y, Tawfik A, Eldawoody H, Hwang P, Rakha A. Nasopharyngeal Angiofibroma Staging with a Novel Nominal Basis: An 18-Year Study in a Tertiary Center. Otolaryngol Head Neck Surg 2019; 161:352-361. [PMID: 31012381 DOI: 10.1177/0194599819842155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a systematic method for anatomic mapping of juvenile nasopharyngeal angiofibroma (JNA) tumors to standardize communication, facilitate surgical planning, and convey prognosis. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. SUBJECTS AND METHODS Following Institutional Review Board approval, we performed a retrospective review of radiologic and angiographic data of patients with JNA presenting to the Department of Otolaryngology-Head and Neck Surgery, Mansoura University, from 2001 to 2017. All patients underwent angiography with embolization and had >1-year follow-up. Based on frequently involved anatomic sites and factors predictive of prognosis, the NSF-COR staging system (nose/nasopharynx, sinus, fossa-cranium, orbit, residual internal carotid artery supply) was developed to explicitly convey anatomic site of involvement and presence of residual vascularity. We validated the NSF-COR staging system against other systems with Pearson chi-square test based on risk factors and clinical outcomes of blood transfusion volume, recurrence, and JNA resectability. RESULTS Fifty-four patients met inclusion criteria, where all primary cases (100%) demonstrated nose/nasopharynx involvement, followed by sinus (85.2%), natural fossae (85.2%), intracranial (26%), and orbital involvement (16.7%). These sites, with assessment of residual internal carotid artery vascular supply, were used to develop the NSF-COR anatomically based staging system. The components COR showed significant association with clinical outcomes of blood transfusion and recurrence. Contingency coefficients between the NSF-COR staging system and available staging systems showed significant correlations (P < .05) for prognosis. CONCLUSION The NSF-COR staging system conveys a communicable anatomic map of JNA tumors that integrates residual vascularity of the tumor and demonstrates strong concordance with current staging systems to assess clinical outcomes.
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Affiliation(s)
- Mohamed Abdelwahab
- 1 Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.,2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Jonathan B Overdevest
- 1 Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Ali Elmokadem
- 3 Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam El-Sisi
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Ahmed El-Kholy
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hesham Zaki
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Elsharawy Kamal
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yasser Khafagy
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali Tawfik
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hany Eldawoody
- 4 Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,5 Department of Neurosurgery, Prince Mohamed Bin Abdul-Aziz Hospital, Riyadh, Saudi Arabia
| | - Peter Hwang
- 1 Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Abdelwahab Rakha
- 2 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Morishita H, Kobayashi M, Takeuchi K. Endoscopic endonasal transmaxillary ligation of a feeding artery and coblation plasma technology enables en bloc resection of advanced juvenile nasopharyngeal angiofibroma without preoperative embolization. Auris Nasus Larynx 2019; 46:306-310. [DOI: 10.1016/j.anl.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/10/2018] [Accepted: 06/17/2018] [Indexed: 11/26/2022]
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Recurrence Rate after Endoscopic vs. Open Approaches for Juvenile Nasopharyngeal Angiofibroma: A Meta-analysis. J Neurol Surg B Skull Base 2018; 80:577-585. [PMID: 31750043 DOI: 10.1055/s-0038-1676562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022] Open
Abstract
Context The effect on recurrence rate between patients with juvenile nasopharyngeal angiofibroma (JNA), treated by an endoscopic versus open approach, has not been well established. Objective A meta-analysis of the available literature concerning recurrence rate in patients who underwent surgery for JNA. Methods A retrospective meta-analysis of studies analyzing recurrence rate after endoscopic or open surgery for patients with JNA was performed using the DerSimonian-Laird random-effects method. English and non-English articles were reviewed using Embase, Medline, and Cochrane databases. Results Among nine studies, including 362 patients from 1981 to 2015, with a mean follow-up of 49.4 months, a total of 89 patients (24.5%) had recurrence. Our analysis revealed a total effect size of -0.16 in favor of endoscopic approach (-0.25 to -0.06, CI [confidence interval] 95%). When analyzing tumor by stage (Radkowski's IA-IIIB n = 299), the endoscopic approach proved to be superior independent of tumor stage (2 vs. 17% for tumors stage IA-IIA, and 26 vs. 32% for tumor stage IIB-IIIB for endoscopic and open approaches respectively; p < 0.05). The endoscopic approach has a statistical significant lower recurrence rate in patients without intracranial compromise when compared with the open approach (13 vs. 28%; p < 0.02). No statistical difference was seen in patients with intracranial compromise ( p = 0.5) Conclusion The use of an endoscopic approach to treat JNA has a significantly lower recurrence rate when compared with open approaches. Independent of disease stage, an endoscopic approach should be the standard of care to surgically treat JNA. For cases with intracranial compromise, either approach can be used for surgical resection.
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Ralli M, Fusconi M, Visconti IC, Martellucci S, de Vincentiis M, Greco A. Nasopharyngeal angiofibroma in an elderly female patient: A rare case report. Mol Clin Oncol 2018; 9:702-704. [PMID: 30546905 DOI: 10.3892/mco.2018.1735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/05/2018] [Indexed: 11/06/2022] Open
Abstract
'Juvenile' nasopharyngeal angiofibroma, which accounts for <1% of all head and neck neoplasms, occurs predominantly in males between 10 and 18 years of age. The small number of patients older than 30 years confirms that presentation after this age is exceptional. Only rare cases of nasopharyngeal angiofibroma in female patients have been documented to date, and some authors believe that sex chromosome studies are indicated in such cases. The pathogenesis of nasopharyngeal angiofibroma remains unknown, but it has been hypothesized that it is a testosterone-dependent tumor. We herein report a particularly rare case of a 68-year-old woman diagnosed with nasopharyngeal angiofibroma and describe the diagnostic and therapeutic workup. This case describes, to the best of our knowledge, the oldest patient reported in the literature.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| | - Massimo Fusconi
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
| | | | | | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, I-00186 Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, I-00186 Rome, Italy
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Tsutsumi S, Ono H, Ishii H, Yasumoto Y. Visualization of the vidian canal and nerve using magnetic resonance imaging. Surg Radiol Anat 2018; 40:1391-1396. [PMID: 30218150 DOI: 10.1007/s00276-018-2105-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have investigated the vidian nerve (VN) and vidian canal (VC) with the use of magnetic resonance imaging (MRI). The present study aimed to characterize the VC and VN using MRI. MATERIALS AND METHODS A total of 91 patients underwent thin-sliced, contrast MRI. The course of the VC and VN and the relationships with relevant structures were analyzed. RESULTS The VC was identified in 95% of axial images on the right side and in 93% on the left. The course of the VC was delineated in 99% of serial coronal images on both sides. The VN location in the VC was highly variable. The course of the VC and transmitting VN was delineated in 95% of sagittal images on the right side and in 91% on the left. The mean length of the VC was 19.8 mm on the right side and 19.3 mm on the left. Topographical relationships between the anterior genu of the petrous internal carotid artery and the posterior end of the vidian canal could be classified into three types. Of these, the type terminating at the level of the petrous carotid was the most predominant, comprising 76% of 182 sides. The course of the VC and transmitting VN could be classified into four types. The straight type was the most predominant and was found in 41%. CONCLUSIONS The VC and transmitting VN are structures with variable morphologies. Contrast MRI is useful for delineating the VC and VN.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Nandhini J, Ramasamy S, Kaul RN, Austin RD. Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling. J Oral Maxillofac Pathol 2018; 22:S73-S76. [PMID: 29491611 PMCID: PMC5824524 DOI: 10.4103/jomfp.jomfp_43_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched.
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Affiliation(s)
- J Nandhini
- Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
| | - S Ramasamy
- Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
| | - Ronak Nazir Kaul
- Department of Oral and Maxillofacial Surgery, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
| | - Ravi David Austin
- Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
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19
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Windfuhr JP, Vent J. Extranasopharyngeal angiofibroma revisited. Clin Otolaryngol 2017; 43:199-222. [PMID: 28714226 DOI: 10.1111/coa.12939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Angiofibromas in the head and neck region usually arise in the nasopharynx, but may also occur elsewhere. This study aims at evaluating the incidence and clinical features of extranasopharyngeal angiofibroma (ENA). MATERIAL AND METHODS Systematic review of the literature (Medline® and Google™ ) up to 31 December 2015. RESULTS 174 cases of ENA were retrieved from a total of 170 publications. In contrast to former publications and previous understanding, the nasal septum was by far the most common site of the disease. Four patients had a congenital lesion, the oldest patient was 87 years old (mean: 28.7 years; median: 23 years). Male gender was predominantly affected, but the sex ratio was more balanced (2.13:1) than in previous reports in the literature until 12/2015. The majority of patients presented with nasal obstruction, either in combination with epistaxis (25.8%) or other symptoms (12.6%). Symptoms had developed within 13.1 months on average (median: 4 months). Brisk bleeding resulted in 11 of 43 biopsy procedures. Surgical resection as first-line therapy was performed in 170 patients. A tumour regrowth within 12 months was registered in four patients. CONCLUSION The increasing awareness of ENA and the willingness to publish case reports-not only in Medline-listed journals-resulted in a significant increase of published case reports lately. Although extremely rare, ENAs have to be taken into account in the differential diagnosis of unclear masses, particularly in adult patients presenting with a rapidly developing nasal obstruction resulting from a nasal septum tumour. Female gender or normal vascularity does not exclude the diagnosis. Transnasal resection is sufficient in most cases, and recurrences are rare. Pathologists as well as clinicians should consider ENA in their differential diagnosis of any mass of the upper airway.
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Affiliation(s)
- J P Windfuhr
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of Maria Hilf, Moenchengladbach, Germany
| | - J Vent
- Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Cologne/Koeln, Germany
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Abstract
OBJECTIVE A modern imaging review is necessary to further define the anatomic origin of the juvenile nasopharyngeal angiofibroma. METHODS After institutional review board approval, a search from January 1998 to January 2013 yielded 33 male patients (aged 10-23 years) with pathologically proven juvenile nasopharyngeal angiofibroma lesions, as well as pretreatment computed tomography/magnetic resonance imaging. Juvenile nasopharyngeal angiofibroma involvement was assessed in the following regions: sphenopalatine foramen, pterygopalatine fossa, vidian canal, nasopharynx, nasal cavity, sphenoid sinus, choana, pterygomaxillary fissure/masticator space, orbit, and sphenoid bone. RESULTS The choana and nasopharynx were involved in all 33 patients. In contrast, only 22 lesions involved the pterygopalatine fossa, 24 lesions involved the sphenopalatine foramen, and 28 lesions involved the vidian canal. CONCLUSIONS Our results suggest that the juvenile nasopharyngeal angiofibroma origin is in the region of the choana and nasopharynx rather than the sphenopalatine foramen or pterygopalatine fossa.
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21
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Huang J, Sacks R, Forer M. Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma. Ann Otol Rhinol Laryngol 2017. [DOI: 10.1177/000348940911801103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives A 2-surgeon technique has been proposed that allows resection of juvenile nasopharyngeal angiofibroma (JNA) with extension into the infratemporal fossa by utilizing a septal incision for passage of a retracting instrument from the opposite nostril. This technique, however, does not overcome the problem of limited space within the nasal cavity for the tumor to be retracted. Therefore, the tumor has to be divided to allow for its removal. We are proposing a different 2-surgeon technique as an alternative operative technique for the resection of JNA. Methods A new technique of endoscopic resection of JNA involves a transseptal posterior perforation. This perforation allows retraction of the tumor into the opposite nasal cavity by the second surgeon. The retraction of the tumor creates space for its resection. Results Nineteen patients (all male) underwent this 2-surgeon technique for resection of JNA. The follow-up period ranged up to 9 years, and no recurrence was recorded. Conclusions Longer-term follow-up is needed to assess recurrence rate and morbidity with this technique. However, in our small series, the 2-surgeon technique via posterior septal perforation was associated with low morbidity and recurrence rates.
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Affiliation(s)
- Johnson Huang
- Department of Ear, Nose and Throat Surgery, Hornsby Hospital, Hornsby, Australia
| | - Raymond Sacks
- Department of Ear, Nose and Throat Surgery, Concord General Hospital, Concord, Australia
| | - Martin Forer
- Department of Ear, Nose and Throat Surgery, Royal North Shore Hospital, St Leonard, Australia
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Janakiram TN, Sharma SB, Kasper E, Deshmukh O, Cherian I. Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas. Surg Neurol Int 2017; 8:55. [PMID: 28540121 PMCID: PMC5421208 DOI: 10.4103/sni.sni_295_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/04/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Juvenile nasal angiofibromas (JNA) is a benign lesion with high vascularity and propensity of bone erosion leading to skull base invasion and intracranial extension. It is known to involve multiple compartments, which are often surgically difficult to access. With evolution in surgical expertise and technical innovations, endoscopic and endoscopic-assisted management has become the preferred choice of surgical management. Over the last four decades, various staging systems have been proposed, which are largely based on the extent of nasal angiofibroma. However, no clear guidelines exist for the stage-appropriate surgical management. In this study, we aim to formulate a novel staging system based on the analysis of high quality preoperative imaging and propose detailed surgical guidelines related to disease stages as observed in 242 primary cases of JNA. METHODS A retrospective analysis of the case records of 242 primary JNA cases was performed at our center. Patients were staged according to various existing staging systems as well as our own new staging system, and outcome variables were compared with respect to intraoperative blood loss, multiple staged operations, and tumor recurrences. Operative records were studied and precise endoscopic surgical guidelines were formulated for each stage. RESULTS Comparing the intraoperative blood loss seen in stages of various classifications, it was found that intraoperative blood loss correlated best and statistically significantly with stages in the newly proposed Janakiram staging system when compared to the existing staging systems. Staged operations were performed in a total of 7/242 patients, and there was a significant association between the requirement of a staged operation and tumor extent (Fischer's exact test, P < 0.001). Tumor recurrence was seen in 22 cases and the pterygoid wedge was found to be the most frequent site of recurrence initially. As the extent of resection improved with better surgical technique over time, recurrences were only found in superior orbital fissure, around the internal carotid artery, and in the middle cranial fossa. CONCLUSION This new Janakiram staging system is based on preoperative imaging data from one of the largest JNA case series reported thus far. Respective guidelines reliably stratify patients into treatment groups with definite surgical approaches and predicts outcome. Improved surgical approaches in the modern endoscopic era have redefined JNA management with improved outcome. This study shows the importance of precise presurgical imaging and the choice of the most suitable surgical approach in reducing morbidity and mortality in JNA surgery.
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Affiliation(s)
- Trichy N Janakiram
- Department of Otolaryngology, Royal Pearl Hospital, Tiruchirapally, Tamil Nadu, India
| | - Shilpee B Sharma
- Department of Otolaryngology, Royal Pearl Hospital, Tiruchirapally, Tamil Nadu, India
| | - Ekkehard Kasper
- Department of Neurosurgical Oncology, BIDMC Cancer Center, Boston, Massachusetts, USA
| | - Onkar Deshmukh
- Department of Otolaryngology, Royal Pearl Hospital, Tiruchirapally, Tamil Nadu, India
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Acharya S, Naik C, Panditray S, Dany SS. Juvenile Nasopharyngeal Angiofibroma: A Case Report. J Clin Diagn Res 2017; 11:MD03-MD04. [PMID: 28571176 DOI: 10.7860/jcdr/2017/23729.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is tumour almost exclusively seen in adolescent males, constituting less than 1% of all neoplasms in head and neck. They are benign and locally spreading and are highly vascular in nature and thus prove to be a surgical challenge because of its complex anatomical location. Here, we present a case report of a 18-year-old male presenting with a mass in his left nasal cavity, with recurrent epistaxis and nasal obstruction. Computed tomography imaging revealed a non-encapsulated lobulated heterogeneous mass lesion in the naso-pharynx and left posterior choana of the nasal cavity, extending to pterygopalatine and infratemporal fossa, masseter space of left side. The approach to its surgical management was a combined multi-disciplinary effort of otorhinolaryngology surgeons and maxillofacial surgeons.
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Affiliation(s)
- Soubhagini Acharya
- Associate Professor, Department of Ear, Nose and Throat, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Choubarga Naik
- Assistant Professor, Department of Dental Surgery, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Siddharth Panditray
- Postgraduate Student, Department of Ear, Nose and Throat, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Subha Soumya Dany
- Senior Resident, Department of Dentistry, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
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Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept. Int J Otolaryngol 2017; 2016:4203160. [PMID: 28101106 PMCID: PMC5215425 DOI: 10.1155/2016/4203160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size. In tumors with extension to parapharyngeal space, the endonasal approach was observed to be inadequate. Combined Endoscopic Endonasal Approaches and Endoscopic Transoral Surgery (EEA-ETOS) approach has provided a customized alternative of multicorridor approach to access JNA for its safe and efficient resection. Methods. The study demonstrates a case series of patients of JNA with prestyloid parapharyngeal space extension operated by endoscopic endonasal and endoscopic transoral approach for tumor excision. Results. The multiport EEA-ETOS approach was used to provide wide exposure to access JNA in parapharyngeal space. No major complications were observed. No conversion to external approach was required. Postoperative morbidity was low and postoperative scans showed no residual tumor. A one-year follow-up was maintained and there was no evidence of disease recurrence. Conclusion. Although preliminary, our experience demonstrates safety and efficacy of multiport approach in providing access to multiple compartments, facilitating total excision of JNA in selected cases.
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25
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Bunch PM. Anatomic Eponyms in Neuroradiology: Head and Neck. Acad Radiol 2016; 23:1319-32. [PMID: 27283070 DOI: 10.1016/j.acra.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
In medicine, an eponym is a word-typically referring to an anatomic structure, disease, or syndrome-that is derived from a person's name. Medical eponyms are ubiquitous and numerous. They are also at times controversial. Eponyms reflect medicine's rich and colorful history and can be useful for concisely conveying complex concepts. Familiarity with eponyms facilitates correct usage and accurate communication. In this article, 22 eponyms used to describe anatomic structures of the head and neck are discussed. For each structure, the author first provides a biographical account of the individual for whom the structure is named. An anatomic description and brief discussion of the structure's clinical relevance follow.
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Sennes LU, Butugan O, Sanchez TG, Bernardi FDC, Saldiva PHN. Tissue Maturation during the Growth of Juvenile Nasopharyngeal Angiofibroma. Ann Otol Rhinol Laryngol 2016; 113:34-8. [PMID: 14763569 DOI: 10.1177/000348940411300107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juvenile nasopharyngeal angiofibroma involves a specific age group and changes from vascular tissue to fibrous tissue. The goal of this study was to investigate the correlation among tumor extension, the histologic characteristics of the tumor, and the patient's age. We performed a prospective study of 43 male patients with untreated juvenile nasopharyngeal angiofibroma (average age, 15.42 years). We correlated the patient's age with the extension of the tumor (analyzing the computed tomographic scan) and the immunohistologic characteristics of the tumor (morphological and morphometric analysis of the central portion of the tumor, the sphenopalatine foramen region). We observed that the larger the tumor, the smaller the number of vessels and cells, but the larger the fibrous component and the higher the grade of maturation of the tissue. The patient's age was not correlated with tumor extension or the histologic characteristics of the tumor. However, the grade of maturation of the tissue in the region of the sphenopalatine foramen was higher in larger tumors.
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Affiliation(s)
- Luiz Ubirajara Sennes
- Department of Otolaryngology, University of São Paulo Medical School, São Paulo, Brazil
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27
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Abstract
Purpose: Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor that exhibits a predictable spreading pattern. Radiologist’s prior knowledge on the tumor’s characteristics aids in establishing a diagnosis. We aimed to report the characteristic Magnetic Resonance Imaging (MRI) findings and the spread patterns of JNA. Materials and methods: We retrospectively evaluated the MRI findings and extension pathways of 6 cases of JNA. Results: The patients’ age ranged from 8 to 16 years and all patients were male. The tumors were classified according to the Onerci system. Tumors were largely isointense to muscle on T1-weighted images and hyperintense on T2-weighted images. All lesions had internal signal-void regions and all exhibited intense enhancement after IV contrast injection. Diffusion restriction was not an associated feature. ADC values for these tumors were high. The evaluation of the available MR angiography studies of three patients showed the blood supply to the tumor to be mainly from the internal maxillary branch of the external carotid artery. In all patients, the diagnosis was based on MR images and a surgical excision was planned. Conclusion: The diagnosis can be established based on the characteristic imaging findings and the clinical history without performing a biopsy.
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28
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Hillel AT, Metzinger RC, Nemechek AJ, Nuss DW. Loss of Reflex Tearing: An Expected Consequence of Juvenile Nasopharyngeal Angiofibroma. Otolaryngol Head Neck Surg 2016; 133:605-10. [PMID: 16213937 DOI: 10.1016/j.otohns.2005.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN AND SETTING: A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia. RESULTS: One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA. CONCLUSION: The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery. SIGNIFICANCE: The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM Rating: C.
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Affiliation(s)
- Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine
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Liu JK, Husain Q, Kanumuri V, Khan MN, Mendelson ZS, Eloy JA. Endoscopic graduated multiangle, multicorridor resection of juvenile nasopharyngeal angiofibroma: an individualized, tailored, multicorridor skull base approach. J Neurosurg 2016; 124:1328-38. [DOI: 10.3171/2014.12.jns141696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Juvenile nasopharyngeal angiofibromas (JNAs) are formidable tumors because of their hypervascularity and difficult location in the skull base. Traditional transfacial procedures do not always afford optimal visualization and illumination, resulting in significant morbidity and poor cosmesis. The advent of endoscopic procedures has allowed for resection of JNAs with greater surgical freedom and decreased incidence of facial deformity and scarring.
METHODS
This report describes a graduated multiangle, multicorridor, endoscopic approach to JNAs that is illustrated in 4 patients, each with a different tumor location and extent. Four different surgical corridors in varying combinations were used to resect JNAs, based on tumor size and location, including an ipsilateral endonasal approach (uninostril); a contralateral, transseptal approach (binostril); a sublabial, transmaxillary Caldwell-Luc approach; and an orbitozygomatic, extradural, transcavernous, infratemporal fossa approach (transcranial). One patient underwent resection via an ipsilateral endonasal uninostril approach (Corridor 1) only. One patient underwent a binostril approach that included an additional contralateral transseptal approach (Corridors 1 and 2). One patient underwent a binostril approach with an additional sublabial Caldwell-Luc approach for lateral extension in the infratemporal fossa (Corridors 1–3). One patient underwent a combined transcranial and endoscopic endonasal/sublabial Caldwell-Luc approach (Corridors 1–4) for an extensive JNA involving both the lateral infratemporal fossa and cavernous sinus.
RESULTS
A graduated multiangle, multicorridor approach was used in a stepwise fashion to allow for maximal surgical exposure and maneuverability for resection of JNAs. Gross-total resection was achieved in all 4 patients. One patient had a postoperative CSF leak that was successfully repaired endoscopically. One patient had a delayed local recurrence that was successfully resected endoscopically. There were no vascular complications.
CONCLUSIONS
An individualized, multiangle, multicorridor approach allows for safe and effective surgical customization of access for resection of JNAs depending on the size and exact location of the tumor. Combining the endoscopic endonasal approach with a transcranial approach via an orbitozygomatic, extradural, transcavernous approach may be considered in giant extensive JNAs that have intracranial extension and intimate involvement of the cavernous sinus.
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Affiliation(s)
- James K. Liu
- Departments of 1Neurological Surgery and
- 2Otolaryngology–Head Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | | | | | - Jean Anderson Eloy
- Departments of 1Neurological Surgery and
- 2Otolaryngology–Head Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
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In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma. The Journal of Laryngology & Otology 2016; 130:462-73. [DOI: 10.1017/s0022215116000773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.Methods:Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.Results:The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).Conclusion:These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.
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Thakar A, Hota A, Bhalla AS, Gupta SD, Sarkar C, Kumar R. Overt and occult vidian canal involvement in juvenile angiofibroma and its possible impact on recurrence. Head Neck 2015; 38 Suppl 1:E421-5. [DOI: 10.1002/hed.24012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 11/24/2014] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alok Thakar
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
| | - Ashutosh Hota
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
| | - Ashu Seth Bhalla
- Department of Radiodiagnosis; All India Institute of Medical Sciences; New Delhi
| | | | - Chitra Sarkar
- Department of Pathology; All India Institute of Medical Sciences; New Delhi
| | - Rakesh Kumar
- Department of Otolaryngology and Head and Neck Surgery; All India Institute of Medical Sciences; New Delhi
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Gupta S, Gupta S, Ghosh S, Narang P. Juvenile Nasopharyngeal Angiofibroma: Case report with review on role of imaging in diagnosis. Contemp Clin Dent 2015; 6:98-102. [PMID: 25684921 PMCID: PMC4319355 DOI: 10.4103/0976-237x.149301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma is a locally aggressive benign vascular neoplasm, composed of vasogenic and myofibroblastic elements, accounts for 0.05-0.5% of all the head and neck neoplasms. There are very few case reports of nasopharyngeal angiofibroma involving the oral cavity; we report a case involving both the maxilla and mandible in a 17-year-old patient who reported with a large firm swelling on right side of face with recurrent epistaxis and headache. Magnetic resonance angiography revealed a large lobulated enhancing soft tissue mass, which was hypointense on T1-weighted image and heterogeneously hyperintense on T2-weighted image causing expansion of pterygopalatine fossa and sphenopalatine foramen with extension into the sphenoid sinus, ethmoid air cells, right nasal cavity, right infratemporal fossa and right maxillary sinus with remodeling of right zygomatic arch and part of body and ramus of mandible. It was supplied by the right external carotid artery. Patient was referred to the department of neurosurgery for further management. The diagnosis at an early stage is important because it is associated with high risk of morbidity, but advances in imaging, and surgical methods of treatment have changed the sites associated with high risk of morbidity.
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Affiliation(s)
- Shikha Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Science, New Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Science, New Delhi, India
| | - Sujoy Ghosh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Science, New Delhi, India
| | - Poonam Narang
- Department of Radio Diagnosis, GB Pant Hospital, New Delhi, India
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Griauzde J, Srinivasan A. Imaging of Vascular Lesions of the Head and Neck. Radiol Clin North Am 2015; 53:197-213. [DOI: 10.1016/j.rcl.2014.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Invasive growth patterns of juvenile nasopharyngeal angiofibroma: radiological imaging and clinical implications. Acta Radiol 2014; 55:725-31. [PMID: 24132768 DOI: 10.1177/0284185113506189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is a benign lesion with locally aggressive nature. Knowledge of its typical growth patterns is crucial for precise preoperative staging and adequate preoperative patient counseling. This pictorial essay focuses on characteristic radiological features and paths of invasive growth of this rare tumor. Also, the impact of accurate preoperative evaluation of tumor extensions on surgical planning and results of treatment are discussed.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Marcin Szymański
- Department of Otolaryngology, Medical University of Lublin, Poland, Lublin
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Abstract
In this article, the authors review general principles and technical details of preoperative embolization of various hypervascular head, neck, and spinal tumors encountered in contemporary neuroendovascular practice. Indications, treatment goals, techniques, outcomes, and complications are discussed, and illustrative case examples are presented.
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Affiliation(s)
- Ramsey Ashour
- Department of Neurological Surgery, Lois Pope LIFE Center, University of Miami Miller School of Medicine, 1095 Northwest 14th Terrace, 2nd Floor, (D4-6), Miami, FL 33136-1060, USA.
| | - Ali Aziz-Sultan
- Department of Neurosurgery, Brigham & Women's Hospital, 75 Francis Street, PBB-311, Boston, MA 02115, USA
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Perić A, Sotirović J, Cerović S, Zivić L. Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2014; 56:133-41. [PMID: 24693794 DOI: 10.14712/18059694.2014.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Two types of lateral extension in juvenile nasopharyngeal angiofibroma: diagnostic and therapeutic management. Eur Arch Otorhinolaryngol 2014; 272:159-66. [PMID: 24599598 PMCID: PMC4282713 DOI: 10.1007/s00405-014-2965-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive nasopharyngeal tumor. Apart from anterior lateral extension to the pterygopalatine fossa, it may spread laterally posterior to the pterygoid process, showing posterior lateral growth pattern, which is less common and more difficult to identify during surgery. We analyzed the routes of lateral spread, modalities useful in its diagnosis, the incidence of lateral extension and its influence on outcomes of surgical treatment. The records of 37 patients with laterally extending JNA treated at our institution between 1987 and 2011 were retrospectively evaluated. Computed tomography was performed in all patients and magnetic resonance imaging in 17 (46 %) patients. CT and MRI were evaluated to determine routes and extension of JNA lateral spread. Anterior lateral extension to the pterygopalatine fossa occurred in 36 (97 %) patients and further to the infratemporal fossa in 20 (54 %) patients. In 16 (43 %) cases posterior lateral spread was observed: posterior to the pterygoid process and/or between its plates. The recurrence rate was 29.7 % (11/37). The majority of residual lesions was located behind the pterygoid process (7/11). Recurrent disease occurred in 3/21 patients with anterior lateral extension, in 7/15 patients with both types of lateral extensions and in 1 patient with posterior lateral extension. JNA posterior lateral extension may spread behind the pterygoid process or between its plates. The recurrence rate in patients with anterior and/or posterior lateral extension is significantly higher than in patients with anterior lateral extension only. Both CT and MRI allow identification of the anterior and posterior lateral extensions.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland,
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Szewczyk-Bieda MJ, White RD, Budak MJ, Ananthakrishnan G, Brunton JN, Sudarshan TA. A whiff of trouble: tumours of the nasal cavity and their mimics. Clin Radiol 2014; 69:519-28. [PMID: 24525221 DOI: 10.1016/j.crad.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
A range of disease entities can affect the nasal cavity, often presenting with variable and non-specific symptoms. There is considerable overlap between the clinical and radiological features of neoplastic and non-neoplastic entities. The nasal cavity is often included in routine imaging of the brain, middle ear, skull base, and paranasal sinuses and should be included as a critical review area. The definitive diagnosis is in most cases confirmed by histopathological analysis. However, this review highlights the role of imaging in identifying nasal cavity disease, eliciting features of aggressive or indolent behaviour, and helping to narrow the differential diagnosis, thus facilitating a systematic approach when reviewing the nasal cavity.
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Affiliation(s)
- M J Szewczyk-Bieda
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK.
| | - R D White
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - M J Budak
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - G Ananthakrishnan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, Manchester Royal Infirmary Hospital, Manchester, UK
| | - J N Brunton
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - T A Sudarshan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
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Mathur NN, Vashishth A. Extensive nasopharyngeal angiofibromas: the maxillary swing approach. Eur Arch Otorhinolaryngol 2014; 271:3035-40. [PMID: 24389983 DOI: 10.1007/s00405-013-2804-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibromas. A retrospective analysis in a tertiary care center revealed five cases with extensive nasal angiofibromas operated using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to the lateral-most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus, while another had severe temporal lobe compression through the roof of the infratemporal fossa. All patients underwent tumor excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.5 h. Post-operative healing was satisfactory with palatal fistula formation in two cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibromas and leads to optimal anatomical exposure with minimal morbidity.
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Affiliation(s)
- Neeraj Narayan Mathur
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
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Prabhu SM, Irodi A, Khiangte HL, Rupa V, Naina P. Imaging features of rhinosporidiosis on contrast CT. Indian J Radiol Imaging 2013; 23:212-8. [PMID: 24347850 PMCID: PMC3843328 DOI: 10.4103/0971-3026.120267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Rhinosporidiosis is a chronic granulomatous disease endemic in certain regions of India. Computed tomography (CT) imaging appearances of rhinosporidiosis have not been previously described in the literature. Aims: To study imaging features in rhinosporidiosis with contrast-enhanced CT and elucidate its role in the evaluation of this disease. Materials and Methods: Sixteen patients with pathologically proven rhinosporidiosis were included in the study. Contrast-enhanced CT images were analyzed retrospectively and imaging findings were correlated with surgical and histopathologic findings. Results: A total of 29 lesions were found and evaluated. On contrast-enhanced CT, rhinosporidiosis was seen as moderately enhancing lobulated or irregular soft tissue mass lesions in the nasal cavity (n = 13), lesions arising in nasal cavity and extending through choana into nasopharynx (n = 5), pedunculated polypoidal lesions arising from the nasopharyngeal wall (n = 5), oropharyngeal wall (n = 2), larynx (n = 1), bronchus (n = 1), skin and subcutaneous tissue (n = 2). The inferior nasal cavity comprising nasal floor, inferior turbinate, and inferior meatus was the most common site of involvement (n = 13). Surrounding bone involvement was seen in the form of rarefaction (n = 6), partial (n = 3) or complete erosion (n = 3) of inferior turbinate, thinning of medial maxillary wall (n = 2), and septal erosion (n = 2). Nasolacrimal duct involvement was seen in four cases. Conclusions: Contrast-enhanced CT has an important role in delineating the site and extent of the disease, as well as the involvement of surrounding bone, nasolacrimal duct and tracheobronchial tree. This provides a useful roadmap prior to surgery.
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Affiliation(s)
- Shailesh M Prabhu
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hannah L Khiangte
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Rupa
- Department of Oto-Rhino-Laryngology, Christian Medical College, Vellore, Tamil Nadu, India
| | - P Naina
- Department of Oto-Rhino-Laryngology, Christian Medical College, Vellore, Tamil Nadu, India
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Ballah D, Rabinowitz D, Vossough A, Rickert S, Dunham B, Kazahaya K, Cahill A. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clin Radiol 2013; 68:1097-106. [DOI: 10.1016/j.crad.2013.05.092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/09/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
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Kamat A, Goldstein GH, Kennedy DW. Juvenile nasopharyngeal angiofibroma resection: novel technique to improve posterior/inferior margin control. Laryngoscope 2013; 124:1088-9. [PMID: 24108672 DOI: 10.1002/lary.24391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/04/2013] [Accepted: 08/12/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Ameet Kamat
- Hospital of the University of Pennsylvania, Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, U.S.A
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43
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Uncommon presentation of a benign nasopharyngeal mass in an adolescent: comprehensive review of pediatric nasopharyngeal masses. Case Rep Pediatr 2013; 2013:816409. [PMID: 23936713 PMCID: PMC3727118 DOI: 10.1155/2013/816409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/21/2013] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal masses in the pediatric population are quite rare, and the majority of these are benign. In adolescent boys, there should be a high index of suspicion for juvenile nasopharyngeal angiofibromas. When malignant, the most common lesions encountered are rhabdomyosarcomas, carcinomas, and lymphomas. We report a single case from a tertiary care institution of an adolescent male with an unusual presentation of a benign nasopharyngeal mass and provide a comprehensive review of pediatric nasopharyngeal masses. Whenever possible, radiographic imaging should be obtained, in addition to biopsy, to assist in the diagnosis of pediatric nasopharyngeal masses.
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Iovanescu G, Ruja S, Cotulbea S. Juvenile nasopharyngeal angiofibroma: Timisoara ENT Department's experience. Int J Pediatr Otorhinolaryngol 2013; 77:1186-9. [PMID: 23732022 DOI: 10.1016/j.ijporl.2013.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 11/20/2022]
Abstract
UNLABELLED Juvenile nasopharyngeal angiofibroma is a histologically benign, but very aggressive and destructive tumor found exclusively in young males. The management of juvenile nasopharyngeal angiofibroma has changed in recent years, but it still continues to be a challenge for the multidisciplinary head and neck surgical team. OBJECTIVE The purpose of this study was to review a series of 30 patients describing the treatment approach used and studying the outcome of juvenile nasopharyngeal angiofibroma in the ENT Department Timisoara, Romania for a period of 30 years. METHODS The patients were diagnosed and treated during the years 1981-2011. All patients were male. Tumors were classified using Radkowski's staging system. Computed tomography and magnetic resonance imaging allowed for accurate diagnosis and staging of the tumors. Biopsies were not performed. Surgery represented the gold standard for treatment of juvenine nasopharyngeal angiofibroma. All patients had the tumor removed by an external approach, endoscopic surgical approach not being employed in this series of patients. RESULTS All patients were treated surgically. Surgical techniques performed were: Denker-Rouge technique in 13 cases (43.33%), paralateronasal technique in 7 cases (23.33%), retropalatine technique in 5 cases (16.66%) and transpalatine technique in 5 cases (16.66%). No preoperative tumor embolization was performed. The recurrence rate was 16.66%. The follow-up period ranged from 1 year to 12 years. CONCLUSIONS Management of juvenile nasopharyngeal angiofibroma remains a surgical challenge. Clinical evaluation and surgical experience are very important in selecting the proper approach. A multidisciplinary team, with an experienced surgeon and good collaboration with the anesthesiologist are needed for successful surgical treatment.
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Affiliation(s)
- Gheorghe Iovanescu
- Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Romania.
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45
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46
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Boghani Z, Husain Q, Kanumuri VV, Khan MN, Sangvhi S, Liu JK, Eloy JA. Juvenile nasopharyngeal angiofibroma: A Systematic Review and Comparison of Endoscopic, Endoscopic-Assisted, and Open Resection in 1047 Cases. Laryngoscope 2013; 123:859-69. [DOI: 10.1002/lary.23843] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 11/07/2022]
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47
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Khanna P, Ray BR, Sinha R, Kumar R, Sikka K, Singh AC. Anaesthetic management of endoscopic resection of juvenile nasopharyngeal angiofibroma: our experience and a review of the literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Khanna
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - BR Ray
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - R Sinha
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
| | - K Sikka
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
| | - AC Singh
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
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Nishiike S, Shikina T, Maeda H, Hio S, Inohara H. [Juvenile nasopharyngeal angiofibroma--evaluation of the invasion of the pterygoid canal]. ACTA ACUST UNITED AC 2012; 115:965-70. [PMID: 23265075 DOI: 10.3950/jibiinkoka.115.965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We operated on three patients with juvenile nasopharyngeal angiofibroma in the past 3 years. The endoscopic transnasal approach was utilized in all the cases, and in one case it was accompanied with a Caldwell-Luc procedure. All the tumors were located around the sphenopalatine foramen, but also had involved and enlarged the pterygoid canal. All the cases underwent preoperative selective embolization, but it was difficult to embolize the branch of the internal carotid artery. A partial resection of the middle turbinate facilitated the manipulation of the sphenopalatine foramen and the pterygoid canal. Endoscopic management of juvenile nasopharyngeal angiofibroma should be considered as a first-choice option for tumors at the early stage.
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Affiliation(s)
- Suetaka Nishiike
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine
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Bradoo R, Nerurukar N, Joshi A, Muranjan S. Endoscopic excision of Angiofibroma. Indian J Otolaryngol Head Neck Surg 2012; 53:51-3. [PMID: 23119752 DOI: 10.1007/bf02910980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present a case of Juvenile Nasopharyngeal Angiofibroma (JNA) managed by endoscopic excision alone. The selection of the case, technical difficulties and the advantages offered by this technique are detailed.
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Affiliation(s)
- R Bradoo
- Dept of ENT, L.T.M.M. College & L.T.M.G. Hospital, Sion, 400 022 Mumbai
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50
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Santos-Franco JA, Lee A, Campos-Navarro LA, Tenorio-Sánchez J, Zenteno M, Osorio-Alvarado AR. Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note. Vasc Endovascular Surg 2012; 46:559-64. [PMID: 22903329 DOI: 10.1177/1538574412456436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.
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Affiliation(s)
- J A Santos-Franco
- Department of Neurosurgery and Neurological Endovascular Therapy, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), Universidad Nacional Autónoma de México (UNAM); Mexico City, Mexico
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